job application form template · web viewbluewood care limited is committed to an anti-fraud...

Job Application Form Bluewood Care Limited 2018

Post Applied for:

Post Number:

Application for EmploymentClosing Date: Interview

Date:

Complete this form fully

THE INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED IN CONFIDENCE.

Section 1 Personal detailsLast Name: First Name:

Address:

Postcode:

Home Telephone No:/

Daytime Telephone No: -*

Mobile Telephone No:

National Insurance No:

E-mail address:

Can we contact you at work?Yes

No

Are you free to remain and take up employment in the UK with no current immigration restrictions? Yes No

Job Share DetailsAre you applying on a job share basis? Yes No

Driving Licence – if relevant to post applied for.Do you hold a full, clean driving licence valid in the UK? Yes No

Date of Birth

Bluewood Care Limited 2017 1


If you are successful you will be required to provide relevant evidence of the above details prior to your appointment.

Section 2 Present EmploymentPresent Employment (If now unemployed give details of last employer)

Name of Employer:

Address:

Postcode:

Post Title:

Date of Appointment: Salary:

Department / Section:

Brief description of duties:

Continue on a separate sheet if necessary

Period of Notice: Last day of service(if no longer employed):



Reason for leaving(if no longer employed):



Section 3 Previous EmploymentPrevious Employment (most recent employer first). Please cover the last 10 years and state nature of business - if not public sector

Name of Employer:

Address:

Postcode

Position Held: From: To:

Summary of duties:

Reason for leaving:

Name of Employer:

Address:

Postcode


Summary of duties:

Reason for leaving:

Name of Employer:

Address:

Postcode


Summary of duties:



Reason for leaving:



Section 4 EducationQualifications obtained from Schools, Colleges and Universities. Please list highest qualification first:

College or University Course Qualifications and grades obtained

School Subjects Qualifications and grades obtained


Professional, Technical or Management QualificationsPlease give details:

Professional/Technical/Management Qualifications Course Details

Membership of any Professional / Technical Associations- Please state level of Membership:




Section 5 Training and DevelopmentPlease give details of any training and development courses or non-qualifications courses which support yourApplication. Include any on the job training as well as formal courses.

Title of Training Programme or Course Duration of Course




Section 6 Personal StatementAbilities, skills, knowledge and experience.Please use this section to explain in detail how you meet the requirements of the Employee Profile. If you are or have been involved in voluntary/unpaid activities, please also include this information. Attach and label any additional sheets used.




Section 7 Rehabilitation of Offenders Act (1974)The post you are applying for, unless otherwise stated, is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. You are therefore, required to disclose here any convictions (including ‘spent’ convictions) for criminal offences brought against you and any pending court action.

Have you at ANY time been convicted of an offence, spent or unspent? Yes No

If yes, please give details / dates of offence(s) and sentence:

Section 8 Protecting Children and Vulnerable Adults

The following information may be required if the post you are applying for has a requirement for a DBS check

Enhanced ChecksAre you aware of any police enquires undertaken following allegations made against you, which may have a bearing on your suitability for this post?

Yes No

Section 9 Disability Discrimination ActThis Act protects people with disabilities from unlawful discrimination. We actively encourage applications from people with disabilities. The Disability Discrimination Act defines a disabled person as someone who has a physical or mental impairment which has a substantial and adverse long term effect on his or her ability to carry out normal day to day activities.

Do you have a disability which is relevant to your application? Yes No

If yes, please give details:

We will try to provide access, equipment or other practical support to ensure that people with disabilities can compete on equal terms with non-disabled people.

Do we need to make any specific arrangements in order for you to attend the interview? Yes No




Section 10 HealthSuccessful applicants will be required to complete a detailed medical questionnaire and may be required to attend a medical examination prior to being appointed.

Number of days sickness absence in the last 2 years:

Please state number of occasions in the last 2 years:

Have you ever suffered from any of the following? Yes

No Details/Dates

Asthma/Hay fever Any degree of hearing loss Back injury/back problems or back pains/sciatica Bronchitis/pneumonia/pleurisy Chicken Pox Digestive or bowel disorder Dermatitis/skin sensitivity(allergies) Diabetes/thyroid or other gland trouble Epilepsy/frequent fainting Eye disease/injury or defect of vision not corrected by lenses

Heart/circulation illness/hypertension Hepatitis/jaundice Psoriasis/Eczema Psychiatric illness/anxiety depression Rheumatism or arthritis Recurrent infections e.g. sore throats/ear infections Tuberculosis Height Weight No of days of sick in the last 5 years (please provide details)

Are you registered disabled person? Do you have any deformity, which affect movement? Are you receiving medicines, pills or tablets from doctor or on prescription?

Do you have any other physical disabilities other than listed above that could affect your assignment?

How many units of alcohol do you drink per week?

Have you ever been vaccinated, immunised tested for/against any of the following?

Yes

No Details/Dates

Tuberculosis including BCG Heaf,Mantoux or Tina Rubella (German Measles) Rubella Antibody Test Hepatitis A



Hepatitis B Hepatitis B Antibodies Test Tetanus Typhoid Whooping Cough Varicella Measles, Mumps or Rubella (MMR) Poliomyelitis (Polio)



Section 11 ReferencesPlease give the names and addresses of four referees (two of which MUST be your most recent employers). If you are unable to do this, please clearly outline who your referees are. Reference 3 & 4 will only be used should we be unable to contact references 1 or 2.

Reference 1 Reference 2

Name: Name:

Position (job title):

Position (job title):

Work Relationship:

Work Relationship:

Organisation: Organisation:

Address: Address:

Postcode Postcode

Telephone No: Telephone No:

E-mail: E-mail:

Are you willing for this referee to be approached prior to the interview?

Yes NoAre you willing for this referee to be approached prior to the interview?

Yes No



Reference 3 Reference 4

Name: Name:

Position (job title): Position (job title):

Work Relationship:

Work Relationship:

Organisation: Organisation:

Address: Address:

Postcode Postcode

Telephone No: Telephone No:

E-mail: E-mail:

Are you willing for this referee to be approached prior to the interview?

Yes NoAre you willing for this referee to be approached prior to the interview?

Yes No




HR ONLY: (Circle and complete relevant boxes)Application Checked: Yes No By whom:Interview: Yes No Interview Date:Action Taken: Continue Application Hold Application Withdraw Application

Signed: Date:


Banking Details

Bank/Building Society Name................................................................................................................... Account Holder Name.............................................................................................................................. Bank/Building Society Sort Code............................................................................................................ Account Number..................................................................................................................................... Bank/Society Address.............................................................................................................................. ........................................................................................................................ Postcode....................................................



Section 12 Recruitment Monitoring Form

This sheet will be separated from your application form upon receipt and does not form part of the selection process. It will be retained by the Human Resources purely for monitoring purposes.

Application for the post of:

Bluewood Care Limited wants to ensure that all applicants are treated equally whatever their race, colour or ethnic origin. To do this we need to know about the ethnic origin of people who apply to join us. These categories were used in the 2011 Census and are listed alphabetically. Which groups do you most identify with?

Please mark ‘X’ in only ONE box in column A and only ONE box in column B

COLUMN A COLUMN B

ASIAN (A) British or Mixed British (A) Bangladeshi

(B) English (B) Indian

(C) Irish (C) Pakistani

(D) Scottish (D) Any other Asian background (please specify)

(E) WelshBLACK

(F) Any other? (please specify) (E) African

(F) Caribbean

(G) Any other Black background (please specify)

CHINESE(H) Any Chinese background (please specify)

MIXED ETHNIC BACKGROUND(I) Asian and White

(J) Black African and White

(K) Black Caribbean and White

(L) Any other Mixed ethnic background (please specify)

WHITE(M) Any Other White background (please specify)



ANY OTHER ETHNIC BACKGROUND(N) Any other ethnic background (please specify)



Section 12 Recruitment Monitoring Form continued

Gender

Male Female

Sexual OrientationBluewood Care Limited wants to ensure that all applicants are treated equally whatever their sexual orientation. To do this we need to know about the sexual orientation of people who apply to join us. We would therefore be grateful if you would complete the following question. Your answer will be treated in the strictest confidence and will not affect your job application in any way.

Which group do you most identify with? The options are listed alphabetical order.

Please mark ‘X’ in one box only:

Bi-Sexual

Gay woman/lesbian

Gay man

Heterosexual/straight

Other

Prefer not to say

Religion or Belief

What is your religion or belief (including non-belief)? Please mark ‘X’ in the box below as appropriate.

Agnostic Pagan

Atheist Sikh

Rastafarian

Buddhist Scientologist

Christian – Catholic Shinto

Christian – Protestant Zoroastrian

Christian – Other No religion or belief

Hindu Prefer not to say

Humanism Any other religion or belief

Jainism

Jewish Please specify below, if you wish.

Muslim



Disability

Disability is defined as “physical or mental impairment, which has a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities”.

Do you consider yourself disabled? Yes No


Age Group

16-21 21-35 36-45

46-55 56-65 66-70

Over 70

MediaPlease state how you got to know about us



Section 13 Declaration

Are you related to or do you have a close personal relationship with a Bluewood Care Staff Member Yes No

If yes, specify name(s), position(s) and relationship(s)

If appointed, do you have any interests or hold any appointments that may conflict with employment by the Company in the role for which you have applied?If yes, please detail on a separate sheet.

Yes No

B. Statement to be Signed by the ApplicantBluewood Care Limited is committed to an anti-fraud culture and participates in statutory anti-fraud initiatives.

Please complete the following declaration and sign it in the appropriate place below. If this declaration is not completed and signed, your application will not be considered.

I agree that Bluewood Care Limited may use information provided on this form for prevention and detection of crime and it may share this information with other bodies solely for these purposes. I hereby give consent to such collection, storage and processing of my personal data and I agree that the information given on this form may be used for data registration purposes.I hereby certify that:

all the information given by me on this form is correct to the best of my knowledge all questions relating to me have been accurately and fully answered I possess all the qualifications which I claim to hold I have read and, if appointed, am prepared to accept the conditions set out in the conditions of

employment and the job description.

Signed: Date:

R E T U R N I N G T H I S F O R M

By Hand or Post:Bluewood Care Limited The Koco Building,The ArchesSpon End , CoventryCV1 3JQ

By E-Mail:[email protected]

Enquiries:Telephone: 02476 920015


job application form template · web viewbluewood care limited is committed to an anti-fraud...

Documents